Clinical research is increasingly offshored to developing countries, a practice that has generated considerable controversy. It has recently been argued that the prevailing ethical norms governing such research are deeply puzzling. On the one hand, sponsors are not required to offshore trials, even when participants in developing countries would benefit considerably from these trials. On the other hand, if sponsors do offshore, they are required not to exploit participants, even when the latter would benefit from and consent to exploitation. How, it is asked, can it be worse to exploit the global poor than to neglect them when exploitation is voluntary and makes them better off? The present article seeks to respond to this challenge. I argue that mutually beneficial and voluntary exploitation can be worse than neglect when as is typically true of exploitative international research it takes advantage of unjust background conditions. This is because, in such cases, exploitation overlaps with another, less familiar wrong: complicity in injustice. Recognising complicity as a distinct wrong should make us judge exchanges arising from background injustice more harshly than we typically do, in research and elsewhere.

The concept of exploitation and potentially exploitative real-world practices are the subject of increasing philosophical attention. However, while philosophers have extensively debated what exploitation is and what makes it wrong, they have said surprisingly little about what might be required to remediate it. By asking how the consequences of exploitation should be addressed, this article seeks to contribute to filling this gap. We raise two questions. First, what are the victims of exploitation owed by way of remediation? Second, who ought to remediate? Our answers to these questions are connected by the idea that exploitation cannot be fully remediated by redistributing the exploiters gain in order to repair or compensate the victims loss. This is because exploitation causes not only distributive but also relational harm. Therefore, redistributive measures are necessary but not sufficient for adequate remediation. Moreover, this relational focus highlights the fact that exploitative real-world practices commonly involve agents other than the exploiter who stand to benefit from the exploitation. Insofar as these third parties are implicated in the distributive and relational harms caused by exploitation, there is, we argue, good reason to assign part of the burden of remediation to them.